How many times have you wanted to give your husband a piece of your mind – and then thought better of it? According to a new study, biting your tongue isn’t a good idea. Such silence exacts a price…

We’ve all been there: We’re annoyed with our spouse and have a particularly cutting comment ready to let fly, but we decide it’s easier to say nothing and avoid adding to the stress we already feel. However, a recent study suggests that may not be the best decision for women, especially when it comes to having a long and healthy life.

Researchers at Boston University and Eaker Epidemiology Enterprises in Gaithersburg, Maryland, found that a married woman’s health may be more closely linked to the marital strain she experiences than to the happiness or unhappiness she feels in her marriage. Perhaps most important, those who bottle up their feelings may be at increased risk of dying.

The Hazards of Wedded Bliss

The researchers examined data from about 1,800 men and 1,900 women drawn from the famous 50-year Framingham Heart Study, trying to determine if marriage and marital strain were related to heart disease and mortality over a 10-year period. Previous research had suggested that marital strain is associated with heart disease. But this study looked at specific aspects of marital strain and its link to heart disease and death.

What the recent study found breaks new ground in understanding marital stress and health risks. First, women who bit their tongues during a conflict with their spouse had four times the risk of dying compared to women who did not.

Second, men whose working wives were upset by their jobs, which morphed into disruptions at home, were almost three times more likely to develop coronary heart disease than men whose working wives reported greater job satisfaction. (See related story: Does Stress Cause Metabolic Syndrome?)

And third, there was no relationship between couples’ happiness (or unhappiness) in their marriage and the development of coronary disease or death.

This study’s scrutiny of marriage is not new. Much research over the past three decades has examined the health effects of marital strain. A large Israeli study in the 1970s demonstrated that a wife’s love and support helped reduce her husband’s risk of developing angina (chest pain caused by a reduction in blood flow to the heart). In 2000, the Journal of the American Medical Association reported that Swedish women who had been hospitalized for heart attack or angina had a nearly threefold higher risk of recurrence if they reported marital stress.

Another study published in 2002 found that men who divorced had a 40% increased risk of death compared to those who remained married. For men and women with congestive heart failure, four-year survival rates were higher among those who were happily married.

Men and Women Are Different

Previous research has also attempted to understand the reasons behind the link between marital stress and poor health. Not surprisingly, men with underlying hostile feelings react to stressful marital interactions with heightened cardiovascular responses. But wives with underlying hostility don’t show the same heightened cardiovascular responses, suggesting the sexes differ when it comes to handling marital stress.

Other researchers have looked at differences in the way men’s and women’s hormones react to stress, independent of marriage. The researchers measured both heart rates and hormone levels (testosterone for men, estrogen for women) while the men and women reacted to various stressors.

The men’s heart rates and testosterone levels increased significantly when the men responded with hostility. But no evidence linked hostility, depression or anxiety in women with changes in cardiovascular response or estrogen levels. Again, this supports findings that women handle stress differently than men, in or outside of marriage.

Building on Gender Findings

The current study took the research even further, examining factors such as marital strain, marital happiness and satisfaction, disagreements, and feelings of being loved in relation to health effects. It also examined the reaction to conflict with one’s spouse and the effect of a woman’s work outside the home, neither of which had been examined before.

What the researchers found is that the men were more likely to report a happier marriage and more marital satisfaction than the women, although there were no differences in the number of reported marital disagreements between the groups.

But what men and women feel they disagree about seems to vary: Women were more likely than men to report disagreements on family finances, leisure time, raising of children, household chores, and drinking. Men were more likely to report disagreements over sex. (See related story: Talk It Out: 3 Communication Tips for Your Marriage)

No One’s Heart Is Safe

Still, for men anyway, marriage seems a safer state than bachelorhood. For instance, numerous studies have confirmed that married men live longer than unmarried men. The findings extend to recently divorced males, as well, whose suddenly single lives grow shorter (sometimes called “the divorcée’s revenge”).

Less well-studied are the effects of marriage on women. Although women tend to live longer than men and married women may have lower death rates from cardiovascular disease, no one’s yet proven that marriage assures a longer lifespan for women.

Even the Eaker study, which affirms a beneficial relationship between marriage and mortality, undercuts that finding with another significant one: Women who reported that they kept their feelings to themselves when in conflict with their spouses – a process called self-silencing – had more than four times the risk of dying during the 10-year follow-up than women who more freely expressed their feelings.

The theory of self-silencing emerged in the early 1990s. The concept is that a spouse may silence her thoughts and feelings in an effort to maintain safe and intimate relationships. But men and women who self-silence are also more likely to suffer depression, and women to have irritable bowel syndrome.

In the present study, both men and women self-silenced, but the men appeared not to suffer any ill health as a result. Women on the other hand, paid a high price.

The only marital strain that put men at increased health risk was the disruptive effect that a spouse’s work might have at home. If the men noted that their wives were upset by their professional work and that raised a ruckus at home, the men were nearly three times more likely to develop cardiovascular heart disease.

Still, the usual measures of marital strain such as dissatisfaction, unhappiness or disagreements didn’t appear significantly related to heart disease or death.

Vent for Life

If you’re a self-silencer, you may want to try letting loose – not an easy transition for someone used to keeping mum. Below are some suggestions to get you started:

Be respectful.

One reason that you may keep quiet is because you’re afraid you’ll say something you’ll regret. But you can tell your spouse how you feel while still acting respectful of his feelings.

Get specific.

Try to say how you feel beyond generalities such as “bad” or “upset.” Letting your husband know that you’re irritated is different than telling him you’re angry.

Stick with “I”statements.

Saying, “You always…,” will only make your husband feel defensive and cornered. Instead, use sentences that start with “I” such as “I feel tired and annoyed when I come home to a sink full of dirty dishes.”

Sort through the feelings.

You may also keep quiet because the situation is a recurring one or a subject you always fight about. And you may recognize that your husband has his own pressures. However, you can acknowledge all that and still get your own feelings out of your system. For instance, you could say, “I love it when you take out the garbage and I know how busy you are. But I feel busy and stressed at work, too – and burdened by household chores. Can we alternate the days we each do dishes?”

Do You Fight Fair?

No relationship is perfect, and at some point you're going to have a confrontation with a coworker, neighbor or someone you love. Disagreements can be a way to respectfully voice your opinion and carefully consider the other person's thoughts - or they can be an all-out, name-calling fiasco. Is your fighting style fair or do your quarrels need a referee? Take this fighting fair quiz to find out.

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